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High-Definition Mapping–Guided Pulsed Field Ablation Using the OPAL HDx System: A Single-Center Experience
Session:
Sessão de Posters 20 - Gestão moderna de arritmias: do mapeamento à monitorização
Speaker:
Rita Barbosa Sousa
Congress:
CPC 2026
Topic:
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Theme:
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Subtheme:
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Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Samuel Azevedo; Pedro Galvão Santos; Daniel Gomes; Rita Barbosa Sousa; Daniel Matos; Gustavo Rodrigues; João Carmo; Francisco Moscoso Costa; Pedro Carmo; Diogo Cavaco; Francisco Bello Morgado; Pedro Pulido Adragão
Abstract
<p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Background:</strong><br /> High-definition electroanatomic mapping may enhance the precision and efficiency of catheter ablation. The OPAL HDx system (Boston Scientific) integrates ultra–high-density mapping with a streamlined FARAPULSE pulsed field ablation (PFA) workflow, yet real-world evidence on its added value remains limited. We report our initial single-center experience evaluating procedural efficiency, safety, and short-term outcomes using OPAL HDx–guided PFA.</span></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods:</strong><br /> We analyzed 175 consecutive atrial arrhythmia ablation procedures performed between February and November 2025 using the OPAL HDx mapping system integrated with the FARAPULSE PFA platform. All procedures were performed under general anesthesia. Baseline clinical variables included cardiovascular comorbidities, ongoing antiarrhythmic drug therapy, left atrial volume index (LAVI), left ventricular ejection fraction (LVEF), and history of prior catheter ablation.</span></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">Procedural performance metrics included total procedure duration, fluoroscopy time, and radiation dose. Safety endpoints encompassed periprocedural and early postprocedural complications (i.e., cardiac tamponade, stroke, vascular access complications, and death). Arrhythmia recurrence - defined as documented atrial fibrillation or atrial flutter on electrocardiogram, Holter monitoring, or clinical records - was evaluated during follow-up.</span></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results:</strong><br /> The mean patient age was 64 ± 10 years, 61.7% were male, and cardiometabolic comorbidities were prevalent. Atrial fibrillation accounted for 90% of procedures (43% paroxysmal), while atrial flutter represented the remaining 10%; 25% of cases were redo ablations. Regarding ablation lesion sets, 45% underwent pulmonary vein isolation (PVI) alone; 29% received PVI plus a posterior wall isolation (PWI); and 10% underwent PVI plus PWI and an additional linear lesion (e.g., mitral line, anterior wall, roof line, and/or cavotricuspid isthmus). </span></span></span><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">The mean procedure duration was 57 ± 26 minutes, fluoroscopy time was 9.8 ± 6.7 minutes, and a radiation dose of 155 ± 147 mGy. No periprocedural complications were observed. </span></span></span><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">The median follow-up duration was 153 days (IQR 80–227). During follow-up, arrhythmia recurrence occurred in 11 patients (6.3%), with a median time to recurrence of 205 days (IQR 153–243). </span></span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong><br /> In this real-world experience, the OPAL HDx system enabled rapid high-resolution mapping with low fluoroscopy exposure and an excellent safety profile when used as the primary mapping platform for PFA-guided ablation of atrial fibrillation and flutter. These findings support the clinical efficiency and safety of Farapulse integrated in the OPAL HDx mapping software with promising short and mid term results.</span></span></span></p>
Slides
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